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Culture, Medicine, and Psychiatry

, Volume 43, Issue 3, pp 442–467 | Cite as

Identity, Subjectivity, and Disorders of Self in Psychosis

  • Suze G. BerkhoutEmail author
  • Juveria Zaheer
  • Gary Remington
Original Paper

Abstract

Alterations in self-experience are increasingly attended to as relevant and important aspects of schizophrenia, and psychosis more broadly, through a burgeoning self-disorders (SD) literature. At the same time, issues of self, subject, and subjectivity within schizophrenia-spectrum illnesses have also gained attention from researchers across the social sciences and humanities, and from ethnographic research especially. This paper examines the subjective experience of disruptions in self-identity within a cohort of first episode psychosis (FEP) service users, critically engaging with the SD literature and bringing it into conversation with social sciences and humanities scholarship on self and schizophrenia. Drawing findings from an ongoing ethnographic study of young peoples’ experiences with psychosis, we explore meanings of mental distress relating to psychotic episodes and attend to issues of self, identity, and subjectivity. We critique the division between “normal” and “pathological” self-experience that is endorsed within the SD literature, arguing against the notion that fragmentation of self-experience in schizophrenia-spectrum illnesses is indicative of psychopathology. We highlight how experiences categorized as psychosis are also important and complete aspects of one’s social world and inner life and explore the ways in which at least some aspects of disruptions of self-identity stem from clinical situations themselves—in particular, from asymmetries of power within the mental health system. Relating our findings to feminist, postcolonial, and disability studies’ approaches to the “self,” we emphasize the complex interplay between interpersonal, cultural, and structural aspects of self-experience within FEP.

Keywords

First episode psychosis Self-disorders Identity Narrative Ethnography 

Notes

Acknowledgements

This work was supported by the University of Toronto Norris Scholar Award, an educational grant. The authors wish to acknowledge the generosity of the FEP clinic service users and family members in sharing their time and stories, and for constructive feedback from colleagues (especially Dr. Ada Jaarsma) and the reviewers of Culture, Medicine and Psychiatry.

Compliance with Ethical Standards

Conflict of interest

No authors have conflicts of interest to disclose related to this manuscript.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Ethics approval was granted under the CAMH REB (CAMH protocol 098-2014).

References

  1. Alle, M.C., A. d’Argembeau, P. Schneider, J. Potheegadoo, R. Coutelle, J.-M. Danion, and F. Berna. 2016. Self-Continuity Across Time in Schizohprenia: An Exploration of Phenomenological and Narrative Continuity in the Past and Future. Comprehensive Psychiatry. 69: 53-61.Google Scholar
  2. Baier, Annette. 1981. Cartesian Persons. Philosophia 10(3-4): 169-188.Google Scholar
  3. Barrett, Robert J. 1988. Interpretations of Schizophrenia. Culture, Medicine and Psychiatry 12:357-388.Google Scholar
  4. Battaglia, Debbora (ed.) 1995 Problematizing the Self: A Thematic Introduction. In Rhetorics of Self-Making. Berkeley: University of California Press.Google Scholar
  5. Biehl, Joao, Byron Good, and Arthur Kleinman. 2007. Introduction: Rethinking Subjectivity. In Joao Biehl, Byron Good, and Arthur Kleinman (Eds.) Subjectivity: Ethnographic Investigations. Berkeley: University of California Press.Google Scholar
  6. Brett, C.M.C., E.P. Peters, L.C. Johns, P. Tabraham, L.R. Valmaggia, and P. McGuire. 2007. Appraisals of Anomalous Experiences Interview (AANEX): A Multidimensional Measure of Psychological Responses to Anomalies Associated with Psychosis. British Journal of Psychiatry. 191(suppl. 51): S23-S30.Google Scholar
  7. Brison, Susan. 2002. Aftermath: Violence and the Remaking of a Self. Princeton: Princeton University Press.Google Scholar
  8. Cermolacce, Michel, Jean Naudin and Josef Parnas. 2007. The “Minimal Self” in Psychopathology: Re-examining the Self-Disorders in the Schizophrenia Spectrum. Consciousness and Cognition 16: 703-14.Google Scholar
  9. Clare, Eli (2017) Brilliant Imperfection. Grappling with Cure. Durham: Duke University Press.Google Scholar
  10. Corin, Ellen. 1998. The Thickness of Being: Intentional Worlds, Strategies of Identity, and Experience Among Schizophrenics. Interpersonal and Biological Processes 61(2): 133-146.Google Scholar
  11. Corin, Ellen. 1990. Fact and Meaning in Psychiatry: An Anthropological Approach to the Lifeworld of Schizophrenics. Culture, Medicine and Psychiatry. 14: 153-188.Google Scholar
  12. Csordas, Thomas J. 1994. Embodiment and Experience: The Existential Ground of Culture and Self. Cambridge, UK: Cambridge University Press.Google Scholar
  13. De Vos, George A 1985 Introduction: Approaches to the Self for a Psychocultural Perspective. In Culture and Self: Asian and Western Perspectives. G.A. De Vos, A. Marsella, and F. Hsu, eds. London: Methuen.Google Scholar
  14. Estroff, Sue E. 1989. Self, Identity, and Subjective Experiences of Schizophrenia: In Search of the Subject. Schizophrenia Bulletin. 15(2): 189-196.Google Scholar
  15. Foucault, Michel. 1965. Madness and Civilization: A History of Insanity in the Age of Reason. Toronto: Random House of Canada Ltd.Google Scholar
  16. Foucault, Michel 1989 (translated 1973). The Birth of the Clinic: An Archaeology of Medical Perception. Translated by A.M. Sheridan. New York: Routledge.Google Scholar
  17. Fuchs, Thomas. 2010. Temporality and Psychopathology. Phenomenology and the Cognitive Sciences. 12: 75-104.Google Scholar
  18. Geertz, Clifford. 1973. The Interpretation of Cultures. New York: Basic Books, Inc.Google Scholar
  19. Gergel, Tania, and Eduardo Iacoponi. 2017. Psychosis and Identity: Alteration or Loss? Journal of Evaluation in Clinical Practice. 23: 1029-1037.Google Scholar
  20. Geurts, Kathryn L 2002 Culture and the Senses: Embodiment, Identity and Well-Being in an African Community. Ethnographic Studies in Intersubjectivity. Berkeley: University of California.Google Scholar
  21. Grosz, Elizabeth 1995 Space, Time and Perversion: Essays on the Politics of Bodies. New York: Routledge; and Sydney: Allen and Unwin.Google Scholar
  22. Hall, Stuart. 1990. Cultural Identity and Diaspora. In Jonathan Rutherford (ed.), Identity: Community, Culture, Difference. London: Lawrence and Wishart.Google Scholar
  23. Haraway, Donna. 1991. Simians, Cyborgs and Women: The Re-invention of Nature. London: Free Association Books.Google Scholar
  24. Hannes, Karin 2011 Chapter 4: Critical appraisal of qualitative research. In Supplementary Guidance for Inclusion of Qualitative Research in Cochrane Systematic Reviews of Interventions, Version 1 (updated August 2011), ed. by J. Noyes, A. Booth, K. Hannes, A. Harden, J. Harris, S. Lewin, Lockwood C. Cochrane Collaboration Qualitative Methods Group. http://cqrmg.cochrane.org/supplemental-handbook-guidance.
  25. Haug, Elizabeth, Lars Lien, Andrea Raballo, Unni Bratlien, Merete Oie, Ole Andreassen, Ingrid Melle, and Paul Moller. 2012. Selective Aggregation of Self-Disorders in First Treatment DSM-IV Schizophrenia Spectrum Disorders. Journal of Nervous and Mental Disease. 200: 632-636.Google Scholar
  26. Hacking, Ian. 1986. Making Up People. In: Thomas Heller, Morton Sosna, and David Wellbery (Eds.), Reconstructing Individualism: Autonomy, Individuality, and the Self in Western Thought. Palo Alto: Stanford University Press, pp. 222-236.Google Scholar
  27. Hacking, Ian.1995. Rewriting the Soul: Multiple Personality and the Sciences of Memory. Princeton, NJ: Princeton University Press.Google Scholar
  28. Hacking, Ian.1999. The Social Construction of What? Cambridge: Harvard University Press.Google Scholar
  29. Horwitz, Allan. 2012. Social Constructions of Mental Illness. In Harold Kincaid (Ed.), The Oxford Handbook of Philosophy of Social Science. New York: Oxford University Press.Google Scholar
  30. Howes, Oliver D. and Shitij Kapur. 2009. The Dopamine Hypothesis of Schizophrenia: Version III—The Final Common Pathway. Schizophrenia Bulletin. 35(3): 549-562.Google Scholar
  31. Henriksen Mads Gram and Lars Nilsson 2017 Intersubjectivity and Psychopathology in the Schizophrenia Spectrum: Complicated We, Compensatory Strategies, and Self-Disorders. Psychopathology. 50:321-333Google Scholar
  32. Ingstad, Benedicte and Susan Reynolds Whyte (eds.) 1995 Introduction. In Disability and Culture. Berkeley: University of California Press.Google Scholar
  33. Jenkins, Janis H. 2004. Schizophrenia as a Paradigm Case for Understanding Fundamental Human Processes. In Janis Hunter Jenkins and Robert John Barrett (eds.), Schizophrenia, Culture, and Subjectivity. Cambridge University Press, New York.Google Scholar
  34. Jenkins, Janis H. 2015. Extraordinary Conditions: Culture and Experience in Mental Illness. Berkeley: University of California Press.Google Scholar
  35. Jenkins, Janis H. and Elizabeth Carpenter-Song. 2005. The New Paradigm of Recovery from Schizophrenia: Cultural Conundrums of Improvement Without Cure. Culture, Medicine and Psychiatry. 29: 379-413.Google Scholar
  36. Judge, Abigail, M., Sue E. Estroff, Diana O. Perkins, and David L. Penn. 2008. Recognizing and Responding to Early Psychosis: A Qualitative Analysis of Individual Narratives. Psychiatric Services. 59(1): 96-99.Google Scholar
  37. Kleinman, Arthur. 1995. Writing at the Margin: Discourse between Anthropology and Medicine. Berkeley: University of California PressGoogle Scholar
  38. Lambert, Helen, and Christopher McKevitt. 2002. Anthropology in Health Research: From Qualitative Methods to Multidisciplinarity. British Medical Journal. 325: 210-213.Google Scholar
  39. Lester, Rebecca. 2017. Self-governance, Psychotherapy, and the Subject of Managed Care: Internal Family Systems Therapy and the Multiple Self in a US Eating-Disorders Treatment Centre. American Ethnologist. 44(1): 23-35.Google Scholar
  40. Lester, Rebecca. 1997. The (Dis)Embodied Self in Anorexia Nervosa. Social Science and Medicine. 44(4): 479-489.Google Scholar
  41. Lock, Margaret and Vinh Kim Nguyen. 2010. An Anthropology of Biomedicine. Boston: Wiley-Blackwell.Google Scholar
  42. Lysaker, Paul H. and John T. Lysaker. 2002. Narrative Structure in Psychosis: Schizophrenia and Disruptions in the Dialogical Self. Theory and Psychology. 12(2): 207-220.Google Scholar
  43. Martin Alcoff, Linda. 2006. Visible Identities: Race, Gender, and the Self. New York: Oxford University Press.Google Scholar
  44. Metzl, Jonathan. 2010. Introduction: Why “Against Health”? In Jonathan M. Metzl and Anna Kirkland (eds.), Against Health: How Health Became the New Morality. New York: NYU Press.Google Scholar
  45. Mishara, Aaron. 2007. Is Minimal Self Preserved in Schizophrenia? A subcomponents view. Consciousness and Cognition. 16: 715-721.Google Scholar
  46. Morrison, Paul D. and Robin M. Murray. 2005. Schizophrenia. Current Biology. 15(24): 980-984.Google Scholar
  47. Myers, Neely Anne Laurenzo, and Tali Ziv. 2016. “No One Ever Even Asked Me that Before”: Autobiographical Power, Social Defeat, and Recovery among African Americans with Lived Experiences of Psychosis. Medical Anthropology Quarterly. 30(3): 395-413.Google Scholar
  48. Nelson, Barnaby, Josef Parnas, and Louis Sass. 2014. Disturbance of Minimal Self (Ipseity) in Schizophrenia: Clarification and Current Status. Schizophrenia Bulletin 40(3): 479-482.Google Scholar
  49. Nordgaard, Julie, Peter Handest, Anne Vollmer-Larsen, and Josef Parnas. 2017. Temporal Persistence of Anomalous Self-Experience: A 5 Years Follow-up. Schizophrenia Research. 179: 36-40.Google Scholar
  50. Nordgaard, Julie. and Josef Parnas. 2014. Self-Disorders and the Schizophrenia Spectrum: A Study of 100 First Hospital Admissions. Schizophrenia Bulletin 40(6): 1300-1307.Google Scholar
  51. Parnas, Josef and Peter Handest. 2003. Phenomenology of Anomalous Self-Experience in Early Schizophrenia. Comprehensive Psychiatry 44(2): 121-134.Google Scholar
  52. Parnas, Josef. and Mads Gram Henriksen. 2014. Disordered Self in the Schizophrenia Spectrum: A Clinical and Research Perspective. Harvard Review of Psychiatry. 22(5): 251-265.Google Scholar
  53. Parnas, Josef, and Louis Sass 2011 The Structure of Self-Consciousness in Schizophrenia. In Oxford Handbooks Online, ed. Shaun Gallagher.  https://doi.org/10.1093/oxfordhb/9780199548019.003.0023
  54. Perez-Alvarez, Marino, Jose M. Garcia-Montes, Oscar Vallina-Fernandez, and Salvador Perona-Garcelan. 2016. Rethinking Schizohprenia in the Context of the Person and Their Circumstances: Seven Reasons. Frontiers in Psychology. 7: 1650.Google Scholar
  55. Pitts-Taylor, Victoria 2016 Mattering: Feminism, Science, and Corporeal Politics. In Mattering: Feminism, Science, and Materialism, ed. Victoria Pitts-Taylor. New York: New York University Press.Google Scholar
  56. Price, Margaret. 2015. The Bodymind Problem and the Possibilities of Pain. Hypatia. 30(1): 268-284.Google Scholar
  57. Raballo, Andrea, Ditte Saebye, and Josef Parnas. 2011. Looking at the Schizophrenia Spectrum Through the Prism of Self-Disorders: An Empirical Study. Schizophrenia Bulletin 37(2): 344-351.Google Scholar
  58. Ratcliffe, Matthew. 2017. Real Hallucinations: Psychiatric Illness, Intentionality, and the Interpersonal World. Cambridge: MIT Press.Google Scholar
  59. Reeve, Donna. 2002. Negotiating Psycho-Emotional Dimensions of Disability and their Influence on Identity Constructions. Disability and Society. 17(5): 493-508.Google Scholar
  60. Rosenhan, David. 1973. On Being Sane in Insane Places. Science. 179(4070): 250-258.Google Scholar
  61. Sass, Louis. 2014. Self-Disturbance and Schizophrenia: Structure, Specificity, Pathogenesis (Current Issues, New Directions). Schizophrenia Research. 152(1): 5-11.Google Scholar
  62. Sass, Louis, Juan P. Borda, Luis Madeira, Elizabeth Pienkos and Barnaby Nelson. 2018. Varieties of Self Disorder: A Bio-Pheno-Social Model of Schizophrenia. Schizophrenia Bulletin 44(4): 720-727.Google Scholar
  63. Sass, Louis and Joseph Parnas. 2003. Schizophrenia, Consciousness, and the Self. Schizophrenia Bulletin. 29(3): 427-444.Google Scholar
  64. Sass, Louis, Joseph Parnas, and Daniel Zahavi. 2011. Phenomenological Psychopathology and Schizophrenia: Contemporary Approaches and Misunderstandings. Psychiatry and Psychology. 18(1): 1-23.Google Scholar
  65. Shildrick, Margrit. 2002. Embodying the Monster: Encounters with the Vulnerable Self. London: Sage Publications.Google Scholar
  66. Silveira, Celeste, Joao Marques-Teizeira, and Antonio Jose de Bastos-Leite. 2012. More than One Century of Schizophrenia: An Evolving Persepctive. Journal of Nervous and Mental Disease. 200(12): 1054-1057.Google Scholar
  67. Strathern, Marilyn. 1988. The Gender of the Gift: Problems with Women and Problems with Society in Melanesia. Berkeley: University of California Press.Google Scholar
  68. Stevenson, Lisa. 2014. Life Beside Itself: Imaging Care in the Canadian Arctic. Oakland: University of California Press.Google Scholar
  69. Tekin, Serife. 2011. Self-Concept Through the Looking Diagnostic Looking Glass: Narratives and Mental Disorder. Philosophical Psychology. 24(3): 1-24.Google Scholar
  70. Tremain, Shelley. 2001. On the Government of Disability. Social Theory and Practice. 27(4): 617-636.Google Scholar
  71. van Os, Jim and Shijit Kapur. 2009. Schizophrenia. Lancet 374: 635-645.Google Scholar
  72. Van Wolputte, Steven. 2004. Hang on to Your Self: Of Bodies, Embodiment, and Selves. Annual Review of Anthropology. 33: 251-269.Google Scholar
  73. Weiss, Gail. 1999. Body Images. Embodiment as Intercorporeality. New York: Routledge.Google Scholar
  74. Wendell, Susan. 2006. Toward a Feminist Theory of Disability. In The Disability Studies Reader, 2nd ed. Ed. Lennard J. Davis. New York, NY: Routledge.Google Scholar
  75. Willett, Cynthia, Ellie Anderson, and Diana Meyers 2016. Feminist Perspectives on the Self, The Stanford Encyclopedia of Philosophy (Winter 2016 Edition), ed. Edward N. Zalta, https://plato.stanford.edu/archives/win2016/entries/feminism-self/.
  76. Wynter, Sylvia. 2003. Unsettling the Coloniality of Being/Power/Truth/Freedom: Towards the Human, After Man, its Overrepresentation—an Argument. The New Centennial Review. 3.3: 257-337.Google Scholar
  77. Zahavi, Daniel. 2007. Self and Other: The Limits of Narrative Understanding. Royal Institute of Philosophy Supplements. 60: 179-202.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.c/o Post-Graduate Medical Education, Department of PsychiatryThe University of TorontoTorontoCanada
  2. 2.Department of PsychiatryThe University of TorontoTorontoCanada
  3. 3.Centre for Addiction and Mental HealthThe University of TorontoTorontoCanada

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